Saturday, May 31, 2014

If you smoke, your risk of getting lung cancer is as much as 20 times greater than if you don't. But if you smoke and are exposed to other carcinogens such as radon, asbestos, arsenic or chromium, your risk could be 300 times greater, according to "a growing body of research, including two studies under way at the University of Kentucky," reports Laura Ungar of The Courier-Journal.

"The studies help explain why Kentucky’s lung-cancer and death rates
are so much higher than for the rest of the nation," Ungar writes, citing experts. The state leads the nation in lung cancer, "and some Appalachian counties’ rates are more than
double the national average. While Kentucky’s adult smoking rate
of 28 percent is the highest in the nation, it’s not enough to account
for the state’s sky-high lung-cancer rates."

Here are two possible causes: Appalachian counties are high in arsenic and chromium, and Central Kentucky has high potential for radon gas, which can accumulate under buildings. "The National Cancer Institute says radon by itself is the second-leading
cause of lung cancer in the United States, and most radon-related
deaths occur among smokers," Ungar notes. "Kentucky has no laws requiring radon testing for single- or multi-family
homes, schools or businesses; and no laws mandating radon-resistant
construction of new homes," according to Ellen Hahn, a UK professor of nursing and public health.

"While doctors aren’t sure how smoking interacts with such carcinogens in
the body," Ungar writes, "some theorize that when smoking damages lung cells’ DNA, the
lungs become more susceptible to damage from other toxins." (Read more) The map above is interactive on the Kentucky Cancer Registrywebsite. Here's an example of how to display county data, which also shows the beginning of the county list ranked by lung-cancer rate; a map of county lung cancer death rates is also available:

At the University of Kentucky, researchers are developing better strategies to identify lung cancer patients who could participate in clinical trials for new treatments. Lung cancer causes more deaths than any other kind of cancer worldwide, and Kentucky's rates of lung cancer and mortality are the highest in the nation.

Unfortunately, fewer than 1 percent of lung cancer patients participate in clinical trials in part because identifying and recruiting eligible participants is difficult and time-consuming, Mallory Powell writes for UK. The disease is often diagnosed so late that there is little time for clinical trials.

"The combination of the burden of lung cancer in Kentucky and the urgency of identifying patients who are eligible for clinical trials motivated Dr. Eric Durben and his team to devise a more efficient method for screening patient eligibility," Powell writes. Durben is director of the Cancer Research Informatics Shared Resource Facility at UK's Markey Cancer Center and an assistant professor in the division of biomedical informatics in the College of Public Health.
Durbin and his team are using unique electronic data sources managed by UK's Center for Clinical and Translational Science, the Institute for Pharmaceutical Outcomes and Policy, the Markey Cancer Centerand the Kentucky Cancer Registry to create system system to identify patients who for clinical trials. The two-year project is in its seventh month.

"Clinical trial recruitment is critically important to the Markey Cancer Center if we're going to get lifesaving therapeutics to our patients," said Dr. Susanne Arnold, associate professor in medical oncology and radiation medicine at Markey. "It's also how we make progress in cancer treatment."

While the project is geared toward lung cancer, its results could address other cancers. "What's really exciting about Dr. Durbin's study is that it has the potential to greatly improve clinical research not only in the lung cancer but in other cancers and disease conditions as well," said Dr. Nathan Vanderford, assistant director for research at Markey. (Read more)

Bronchitis is a viral infection, and antibiotics are not effective for treating viral infections.

Doctors know this, yet they continue to prescribe antibiotics to patients with bronchitis and other viral infections anyway, Ezra Klein reports on his new website, Vox.

Research shows that doctors prescribe antibiotics for acute bronchitis about 71 percent of the time even though they know that overuse of antibiotics is the leading cause of "superbugs," or organisms that are resistant to some if not all antibiotics, Klein reports. They do this because it makes patients feel better to walk out of the doctor's office with a treatment.

Klein goes on to paint a picture of a post-antibiotic future that could result from doctors prescribing antibiotics for viral infections. Klein reports that patients must stop thinking that good physician care is the result of being treated with an antibiotic, especially in the treatment of bronchitis.

Kentucky and its Southern neighbors overuse more than their share of antibiotics. The southeastern states are the highest users of antibiotics, with twice as many antibiotic prescriptions as states in the Pacific region, according to a study by the Center for Disease Dynamics, Economics & Policy, part of the federal Centers for Disease Control and Prevention.

CDC recommends that every hospital in this country have an antibiotic stewardship program and track their resistance and prescribing patterns. Half of all hospital patients get antibiotics and one-third of the antibiotics prescribed are inappropriate or are unnecessary, CDC Director Tom Frieden told Klein.

Frieden said the world is at risk of losing antibiotics to resistance created by over-prescribing, but a "modest investment" can thwart the most dangerous drug-resistant organisms. Working toward creating new antibiotics and then not falling into the same patterns of abuse must also be part of the solution, Frieden said. (Read more)

Friday, May 30, 2014

The Louisville metropolitan area ranks 49th for fitness among the nation's 50 largest metro areas in the newly released 2014 American Fitness Index, reports Laura Ungar of The Courier-Journal. The ranking is published by the American College of Sports Medicine and is based on 31 indicators of chronic health problems, health behaviors, recreational facilities and physical or built environments.

The Memphis metropolitan area was the only one ranked lower than Louisville. The Louisville metro area includes Jefferson County and eight surrounding counties in Kentucky and four in Indiana.

"There surely is a lot of room for improvement," Dr. Jonathan Becker, a sports medicine specialist at University of Louisville Family Medicine and KentuckyOne Health, told Ungar. "We need to be moving more, eating less and smoking less."

The Washington, D.C., area claimed the top spot as the nation's fittest, rising above Minneapolis-St. Paul, the winner for the last three years.

The negative scores on the index just kept adding up for Louisville, falling way below the targeted fitness index in areas such as smoking, federal aerobic-activity guidelines and the amount of fruits and vegetables consumed per day, Ungar reports. Louisville also had higher levels of disease than the targeted goals for asthma, diabetes and obesity.

"I'm not surprised, based on what I've seen," Patrice Fife, a certified fitness instructor for the Louisville Metro Department of Public Health & Wellness, told Ungar. She said diabetes in the region is "rampant." Overeating is a real problem, and people need to learn more about proper nutrition and portion control, she said: "They need to eat more fresh fruits and vegetables."

City officials and fitness advocates pointed to Louisville's efforts to improve the region's fitness, including programs that bring fresh fruits and vegetables into "food deserts," a ban on smoking ban in public places and expanded smoking-cessation classes. Louisville has also unveiled a plan to curb trans fats in local foods, expand outdoor smoke-free areas and prohibit idling vehicles when air quality is poor, among other things, Ungar notes.

Steve Tarver, chief executive officer of the YMCA of Greater Louisville, told Ungar, "It has taken decades for the Louisville region to become so unhealthy, and it will take a long-term commitment to get healthier. He said it will involve complex issues such as reducing racial and economic health inequities." (Read more)

Thursday, May 29, 2014

Georgia Gov. Nathan Deal has signed into law two bills aimed at thwarting the Patient Protection and Affordable Care Act. One will prevent the College of Family and Consumer Sciences at the University of Georgia from continuing its navigator program to help Georgians get Obamacare coverage once the federal grant of $1.7 million runs out in August.

Deborah Murray

The navigator program sought to educate people about the law, to help them sign up for Medicaid or for coverage on the federal exchange. "People who had never had insurance and hadn't had insurance in a long time got affordable, high-quality insurance," Deborah Murray, the college's associate dean for Extension and outreach, told Kentucky Health News. "People were so appreciative and relieved to know they could now afford health care."

Before going to Georgia, Murray was director of the Health Education in Extension Leadership program in the University of Kentucky's College of Agriculture, which oversees the Cooperative Extension Service in the state. She said only a few other navigator programs are based at universities.

Murray said she knew Obamacare wasn't popular in Georgia, but she still didn't expect the kind of opposition that arose in the legislature. "The role of the university is to educate," she said. "What we were doing is really education focused: giving people the information they needed to make informed decisions."

After the grant runs out, Murray said the Extension Servicewill continue its mission to educate and inform. "Educating the public about health-insurance literacy is part of the Extension and land-grant mission of the university, and we will continue to do that," she said. "Helping people understand health insurance and use it properly will help reduce health care costs." Like Kentucky, Georgia has a network of county extension offices, which they will use to continue informing people about important ideas like preventative care, co-insurance and deductibles, Murray said.

The Georgia legislation also transfers Medicaid expansion authority from the governor's office to lawmakers and bans the creation of a state health insurance exchange like Kentucky's. Although Georgia did not expand Medicaid eligibility to people earning up to 138 percent of the federal poverty level, as Kentucky did, poor people who qualified for it and PeachCare, a state program, could still sign up. "Georgia cannot afford for our Medicaid rolls to swell. Otherwise, we start cutting into the education budget, the transportation budget and the public safety budget," Rep. Jason Spencer, sponsor of HB 943, toldGeorgia Health News.

The notion that electronic cigarettes can help smokers cut back or quit smoking is uproven, says an article in the June issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology. The article contradicts British research suggesting that e-cigarettes could play a positive role in reducing smoking rates for people who try to quit smoking without the aid of prescription medication or professional support.

Photo from U.S. Food and Drug Administration

Manufactures of e-cigarettes say that progressively adding smaller doses of nicotine to the e-cigarette will help smokers quit smoking. But the authors say this theory hasn't been proven and no evidence supports the claims. "Despite the apparent optimism surrounding e-cigarettes and their purported therapeutic role in smoking cessation, there just simply is not enough evidence to suggest that consumers should use e-cigarettes for this purpose," lead author Andrew Nickels says.

Nickels examined the risks of e-cigarettes, including the ongoing dependence on nicotine and dual use of e-cigarettes and regular cigarettes. Dual use is common, with people using e-cigarettes in public and smoking regular cigarettes at home. The researchers found that this behavior continues to expose children and asthma sufferers in the household to secondhand smoke. "It also promotes ongoing nicotine dependence,” says co-author Chitra Dinakar.

Nicotine is an addictive neurotoxin, and the increased use of e-cigarettes has caused an increase in calls to poison centers. The most common adverse health effects from e-cigarettes are nausea and eye irritation, according to the federal Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. More than half the calls involved children under 5.

Because e-cigarettes are fairly new, the article says there could be other long-term health complications that have yet to be discovered. Results of long-term exposure to such substances are unknown.

The U.S. Food and Drug Administration has proposed a rule that will allow it to regulate e-cigarettes. In April, Gov. Steve Beshear signed into law Senate Bill 109, which prohibits the sale of e-cigarettes to minors in Kentucky.

Wednesday, May 28, 2014

Medicare physicians who prescribe drugs in abusive ways can now be expelled by the federal government, Charles Ornstein reports for ProPublica.

This increased oversight of Medicare Part D prescribers could help
decrease the availability of prescription drugs to abusers in Kentucky. More than 1,000 Kentuckians die each year from prescription drug overdoses, and the state has the third-highest overdose death rate in the nation.

Opoids, which are often found in pain medicine, are the most commonly abused prescription drugs, according to the National Institute on Drug Abuse. Hydrocodone, an opoid, is the most
commonly prescribed
controlled substance in
Kentucky, according to the Kentucky All Schedule Prescription Electronic
Reporting (KASPER) system, and is also the most prescribed drug in Part D program, according to ProPublica's Prescriber Checkup, a tool that compares physicians' prescribing patterns among specialties and states.

The Centers for Medicare and Medicaid Services proposed the new rule after ProPublica documented "how Medicare's failure to oversee Part D effectively had enabled doctors to prescribe inappropriate or risky medications, had led to the waste of billions of dollars on needlessly expensive drugs and had exposed the program to rampant fraud," Ornstein writes.

Part D covers 37.5 million seniors and disabled patients, and one in every four prescriptions in the U.S. is paid for by Medicare, costing taxpayers $62 billion in 2012, and experts have complained that Medicare is more interested in providing drugs to patients than in targeting problem prescribers, Ornstein notes. The U.S. Department of Health and Human Services' inspector general has called for tighter controls.

The new rule allows Medicare to drop doctors "if it finds their prescribing abusive, a threat to public safety or in violation of Medicare rules," or if their Drug Enforcement Administration registration certificates are suspended or revoked, Ornstein writes. Problem providers will be identified by prescribing data, disciplinary actions, malpractice lawsuits and other information.

Opponents of the rule have called its definition of "abusive" prescribing too vague. Some worry that patients will lose access to necessary medication if their doctor is removed from the program, Ornstein writes. Medicare officials said they intend to expel providers only in "very limited and exceptional circumstances," saying "It will become clear to honest and legitimate prescribers . . . that our focus is restricted to cases of improper prescribing that are so egregious that the physician or practitioner's removal from the Medicare program is needed to protect Medicare beneficiaries."

The new rule also allows the Medicare center to "compel health care providers to enroll in Medicare to order medications for patients covered by its drug program, known as Part D," Ornstein writes. Now, doctors not enrolled in Medicare can prescribe for Part D patients; they will have to enroll or opt out of the program by June 1, 2015.

The doctors most affected by this will be dentists and Department of Veterans Affairs physicians who provide services not covered by Medicare but have patients who fill prescriptions covered by the program, Ornstein notes. Most health providers are already enrolled. (Read more)

"King's Daughters Medical Center in Ashland has agreed to pay $40.9 million to settle allegations that it fraudulently billed federally-funded health care programs for hundreds of unnecessary heart procedures" from 2006 through 2011, Bill Estep reports for the Lexington Herald-Leader. "The payment is thought to be the largest ever involving suspected health care fraud in the federal court's Eastern District of Kentucky, which covers 67 counties in the eastern half of the state."

The hospital did not admit wrongdoing, but "agreed to internal reforms and to increased monitoring of its claims to federal health-care programs for five years," Estep reports. "Officials at the hospital, which employs 3,500 people, made the 'difficult decision' to settle the investigation rather than spend money defending allegations related to 'old cases,' the hospital said in a statement.
The hospital said that it has received top rankings for its cardiac care from independent panels.
Prosecutors contended that in order to pump up its bottom line, the hospital billed for stent operations and diagnostic catheterizations performed on patients who didn't need them. . . . Doctors also allegedly falsified records to justify payments."

U.S. Attorney Kerry Harvey said the hospital's $40.9 million payment is about double what it gained from improper billing. "Federal law allows for triple damages in cases involving alleged false claims to government programs," Estep notes. Perrye K. Turner, special agent in charge of the FBI in Kentucky, said "The level of funds involved in this matter is staggering. This money has been stolen from the patients and taxpayers."

"The government also argued that King's Daughters had improper relationships with five doctors," Estep reports. "The hospital made unreasonably high payments to the five, and they in turn referred patients to the hospital, prosecutors alleged. . . . The allegations outlined in the settlement are similar to claims in pending state-court lawsuits that doctors at King's Daughters misrepresented the severity of patients' heart conditions in order to justify heart procedures on more than 500 patients."

Estep notes that the settlement "was the third large agreement finalized this year" after Harvey pledged to ramp up efforts against fraud: "Harvey said there are a number of other federal health care fraud investigations underway in Kentucky.

Monday, May 26, 2014

"A mural showing a tobacco harvest has been on display high in
the second-floor rotunda of the Bourbon County Courthouse for
than 100
years," Mary Meehan writes. (Herald-Leader photo)

Bourbon County's strong tobacco heritage is the main obstacle for proponents of a local smoking ban, and similar feelings exist in many Kentucky counties, Mary Meehan reports for the Lexington Herald-Leader in the second of a series of stories about tobacco use in Kentucky.

"At an April political forum at Bourbon County High School, cigarette
butts lined the walkway to the auditorium, although the campus is
designated smoke-free," Meehan writes. "Onstage, candidates for city council and
magistrate were asked whether they would support a smoking ban. Some
said they had fathers or sisters who were longtime smokers who had
cancer, most said they didn't smoke, and a few said they weren't sure
smoking was really a health risk. Of 18 candidates, only one said he would support a smoking ban. He didn't win in last week's primary election."

The forum was organized by Students Making a Change in Our Communities, a youth group advocating a smoking ban. They have helped rejuvenate efforts begun three years ago by the Coalition for a Smoke-Free Bourbon County and Cyndi Steele, health coordinator for the Bourbon County Health Department.

"Twelve of Kentucky's 120 counties and 26 cities have enacted some type of
smoke-free ordinance," Meehan notes. "In Kentucky, 34 percent of the population is
protected by smoke-free laws. Almost all Kentucky cities with bans are
county seats, leaving most of rural Kentucky without smoking
regulations. Efforts to enact a statewide ordinance have failed in the
legislature.

"Across the country, about half the population lives
in places with smoke-free rules, said Cynthia Hallett, executive
director of the nonprofit Americans for Nonsmokers' Rights. She said the
science on the dangers of smoking and exposure to secondhand smoke was
clear, as were the benefits of smoke-free laws. Kids who grow up where
smoking is banned in public places are less likely to smoke, she said.
People tend to quit when towns go smoke-free." (Read more)

Saturday, May 24, 2014

Grace F. Maguire, medical director of the Thomas H. Pinkstaff Medical Home Clinic in Lexington, has been named 2014 Childhood Immunization Champion in Kentucky by the federal Centers for Disease Control and Prevention for her efforts to promote childhood immunization in central Kentucky.

As a pediatrician, Maguire has seen patients with almost every vaccine-preventable disease and has long been a vaccine information resource for her medical colleagues.

For many years, she was the primary immunization educator for trainees at the University of Kentucky in the Department of Pediatrics.
She led the immunization programs for the university's outpatient clinics and helped develop the state's immunization registry.

Now she is medical director of a clinic that serves a unique population of children — those in foster care and those with birth defects, brain injury, cerebral palsy, and other special health care needs. The clinic, under her direction, assures these children receive all appropriate vaccines, including those indicated for high-risk populations.

“Dr. Maguire's leadership and dedication to protecting vulnerable children against disease is not only admirable, but vital to public health’s work in preventing the spread of communicable disease,” Stephanie Mayfield, commissioner of the Kentucky Department for Public Health, said in a news release.

Each year, the CDC and its foundation honor health professionals and community leaders around the country with immunization-champion awards to acknowledge exemplary individuals who go above and beyond to promote immunization among children in their communities.

The Foundation for a Healthy Kentucky is accepting nominations for qualified persons to join its board of directors and its Community Advisory Committee.

The 15-member board is responsible for preserving the foundation’s endowment and upholding its charitable mission of addressing the unmet health care needs of Kentuckians. It is advised by the 31-member advisory committee.

The board expects to elect four new Community Advisory Committee members, who make recommendations to the board, serve as community liaisons, serve on foundation committees, take part in the foundation's annual policy forum and appoint or nominate candidates to the board.

Nominations for the advisory committee are sought from residents of five area development districts: Purchase, Barren River, Lincoln Trail, Buffalo Trace and Fivco. Members should bring diversity to the foundation and not be currently employed in the health sector.

You may nominate yourself or someone else via the online nomination form and attach a resume or bio by June 30. You may submit the nomination online, by mail or vuia email to:
Mary Jo Shircliffe, chief operating officer; Foundation for a Healthy Kentucky; 1640 Lyndon Farm Court, Suite 100; Louisville, KY 40223. Her email is mshircliffe@healthy-ky.org. You will receive an email acknowledgement of the receipt of your submitted nomination. For more information call 502-326-2583 or (toll free) 877-326-2584.

Friday, May 23, 2014

At his first press conference after winning the Republican nomination for a sixth term, U.S. Sen. Mitch McConnell pressed Democratic nominee Alison Lundergan Grimes to clarify her position on the federal health-care reform law but wouldn't say whether his plan to "start over" on the issue would include shutting down the state's successful health-insurance exchange.

"She's been dodging it for a year," McConnell said Friday. "She's been in this race for a year. It's time for her to answer the question, "How do you feel about it?" Grimes, Kentucky's secretary of state, twice refused Wednesday to say how she would have voted on the 2010 law if she had been a senator.

The topic arose when McConnell was asked to reply to Democratic assertions that his pledge to "pull it out root and branch" would end the law's insurance coverage for 415,000 Kentuckians through the state exchange.

The senator didn't answer directly. "This is another good reason why the two of us ought to have a real debate," he said, recalling his post-primary proposal for three Lincoln-Douglas-style debates by the middle of September.

Asked if he would dismantle the state exchanges created under the law, McConnell said he would have created a national market -- "tear down the walls, the 50 separate silos in which health insurance is sold" -- passed medical-malpractice reform, and allowed small businesses to "band together in this international [sic] market."

Asked again, specifically, if he would shut down Kentucky's exchange, which is branded as Kynect, he said "I think that's unconnected to my comments about the overall question here."

While polls have shown the law to be unpopular in Kentucky, a small plurality of voters in a recent poll had a favorable opinion of Kynect. Last fall, the Kentucky Health Issues Poll found that people who weren't sure how the law would affect them and their families had an unfavorable opinion of it, while those who said they did know how it would affect them had a favorable opinion.

In his overall comments about the law, McConnell said a Congressional Budget Office study has predicted that full implementation of the law would still leave 30 million Americans uninsured, covering only 10 million. "What is the cost-benefit ratio of this kind of destruction, this kind of impact, on 16 percent of the economy?" he asked. "The people of this state are entitled to know the answer to the question, 'How do you feel about it?' and I think my opponent has tried to dodge that question."

UPDATE: Joe Sonka of LEO Weekly writes, "According to the CBO, by 2024 the number of uninsured will, in fact, be 31 million people, but without the ACA there would have been 56 million people uninsured. This number takes into account the undocumented immigrants who can’t get insurance because of the lack of immigration reform, and the people who can’t get Medicaid in states that opted out of the Medicaid expansion. That means that when the ACA 'kicks in fully' . . . 26 million will have gained access to health-care coverage because of it."

Asked if repealing the law would be his top priority as majority leader if Republicans take control of the Senate, he said he wasn't ready to say because he's not in the majority yet, "but I think it's reasonable to assume that would be a high priority for us." He noted that Obama will be president until January 2017, an implicit acknowledgement that Obama would veto any repeal and two-thirds votes of the House and Senate would be required to override him.

Jason Millman of The Washington Postwrites that the issue could be pivotal in the race. "Kentucky is about as big of an Obamacare paradox that you could find:
the state's exchange is working well, but Obamacare remains unpopular in
the state," he writes. "It’s also home to one of the more successful
Obamacare health insurance exchanges." He concludes, "Grimes may want to have a better answer the next time she's asked whether she would have voted for the health-care law." She has refused to say.

One of the best parts of summer is splashing in a pool, playing in the back yard sprinkler or swimming in a lake or stream, but recreational water activity always comes with a risk of drowning.

It's important not to lose sight of this risk as you strive to keep your children and adolescents safe, writes Susan Pollack, director of the Pediatric and Adolescent Injury Prevention Program at the Kentucky Injury Prevention and Research Center at the University of Kentucky.

"Every year in Kentucky, an average of 14 children die by drowning. About half the drowning deaths occur among children ages 1 to 4," Pollack writes in the Lexington Herald-Leader. "From 2009-11, 80 percent of childhood drowning deaths occurred at the child’s residence or someone else’s home. A quarter of drowning deaths occurred among adolescents, mostly while swimming, boating or fishing on lakes and rivers."

Prevention requires constant supervision of toddlers and children around all types of water. This not only includes the obvious such as pools, swift-flowing creeks and large bodies of water, but also bath-tubs, car-washing buckets and ornamental ponds, Pollack says. Toddlers can fall in and drown even in just a few inches of standing water in a bucket. It is also important to empty baby pools immediately after use.

Drowning can happen "swiftly and silently," Pollack writes. This requires a responsible adult to supervise children at all times, even if lifeguards are present. And if a child can't swim, this adult should be within arms-reach. Supervision is needed even if the child is wearing an appropriately sized Coast Guard-approved life vest. Floaties and water-wings are not sufficient life-saving devices.

It is also important to create barriers to water sources. This can be accomplished by putting a four-sided, 4-foot-high fence with a self-closing gate around backyard pools or removing the ladder from above-ground pools that are not fenced.

While teaching children to swim does not replace supervision, it is an important life-saving skill children should learn, Pollack writes. The YMCA, Red Cross and university swim programs all offer lessons.

Adolescents should be reminded to never swim without a buddy and that alcohol and boating never mix, Pollack says. They should also be reminded of the dangers of swimming while fatigued and the importance of wearing a U.S. Coast Guard-approved life jacket when boating. (Read more)

Kentucky citizens with traditional Medicaid coverage may switch to a different managed-care organization (MCO) until June 18, Kentucky Voices for Health Board Chair Sheila Schuster notes in a press release.

The option is open to traditional Medicaid members enrolled with Coventry/MH Net or WellCare, except those in Region 3 (Jefferson and 15 area counties). Switching is voluntary. If members take advantage of the option, coverage with any new MCO will start July 1.

Until June 18 eligible Medicaid members can switch to Humana-CareSource, Passport Health Plan, Anthem Health Plans, CoventryCares/MH Net or WellCare. To learn details about each of the MCOs call 1-855-446-1245 or click here or here.

Eligible members can change MCOs by calling 1-855-446-1245 between 8 a.m. and 5 p.m. EDT and speaking with a Medicaid member representative. They should be prepared to give the birthdate and Social Security number of each person listed on their letter from Kentucky Medicaid. (Read more)

Thursday, May 22, 2014

Psychiatric patients' demand for emergency-room care has been a concern in hospitals, and it's going to get worse. Even though ERs are not properly equipped to help psychiatric patients, people still often go there with psychiatric concerns. Most ERs simply lack room to deal with such situations. According to a survey, 84 percent of emergency physicians say they have psychiatric patients "boarded" in their emergency departments awaiting transfer to a mental-health facility, Adrianna McIntyre writes for Vox.
"People having a mental-health crisis seek care in emergency departments because other parts of the health care system have failed them," said Alex Rosenau, president of the American College of Emergency Physicians.

A psychiatric patient who shows up to the emergency room may require immediate care at the hospital, and sometimes there isn't an open bed in the right department. Those shortages often necessitate psychiatric patients to wait in the emergency room, or board, until space elsewhere opens for them. Both the closure of psychiatric facilities and diminished state funding have contributed to the issue. "Between 1955 and 1997, total state spending on mental health fell 30 percent, a period during which most health spending grew rapidly," McIntyre writes.

If hospitals don't figure out how to deal with the problem, it's going to get worse. In fact, experts say the implementation of the Patient Protection and Affordable Care Act will only exacerbate the problem. Some studies reveal that insured patients are more inclined to go to the emergency room—even for non-urgent issues—because the cost usually isn't as high. Lower-income people are even more likely to do that, and this population will comprise many of the newly insured citizens.

Though hospitals want people to use the health system properly, they also want to make sure patients do visit the ER when it really is necessary. "We don't want to impose any barriers on people going to the emergency room," said Hans House, a clinical professor at the Iowa University Carver College of Medicine. "We don't want people to be afraid to go to the ER."

The Affordable Care Act has provided more funding for reimbursement of emergency psychiatric care in Medicaid, a service the public program doesn't generally cover. However, this doesn't address the lack of space in emergency departments. "We know that a lack of psychiatrists available and staffing patient beds is a barrier," House said. "That's a personnel issue." (Read more)

Ashley Loan graduated from the University of Kentucky College of Medicine on May 17 and plans to practice emergency care medicine in rural Kentucky, Elizabeth Adams reports in a UK press release.

Loan began working toward her goal four years ago as one of 10 graduating students who participated in UK's
Rural Physician Leadership Program, where she believes her roots in
Greenup County prepared her for a future responding to medical
emergencies in rural Kentucky, Adams reports.

Loan told Adams that her earliest experiences in emergency medicine were watching her
mother, Elizabeth Loan, respond to accidents in the farming community because she had an associate's
degree in nursing and was the most educated health care
provider within a 10-mile radius of the Loan farm.

Her daughter recalled that when the neighbor's
son went into a diabetic coma, her mother rushed to
their house to administer sugar. Another time, her mother administered CPR to a farmer who was pinned under a tractor until the emergency responders arrived.

"There have been a lot of instances when my mom was the sole health care provider," Loan said.

Loan told Adams that she understands cultural characteristics that influence health in rural populations, such as an attitude of self-reliance that results in attempts to self-medicate or postpone visits to the doctor. It's often difficult for doctors from urban environments to appreciate those cultural variances.

"I get why people don't go to the doctor—rural people are raised to take care of themselves," Loan said. "Before they come to the doctor, they've tried a few things."

Loan told Adams she also understands first-hand some of the health challenges found in rural communities. Her father, a longtime tobacco farmer and user, suffers from chronic obstructive pulmonary disease.

Kentucky has the nation's highest rate of COPD, 9.3 percent of the population, according to the federal Centers for Disease Control and Prevention. Tobacco use is the primary cause, but air pollution and genetics can also play a role.

Loan told Adams that growing up in a rural area isolated from hospitals fueled her desire to deliver more efficient emergency medical care to rural communities. She said she "enjoys the challenge of being the first doctor on the trauma scene and 'Macgyver-ing' her way through emergencies with limited resources."

"I love the fact that patients who come to the emergency department are the sickest patients you are going to see," Loan said. "You lay your eyes on them; you have no previous notes—you are the person who has an hour before the patient crashes to figure out what's going on."

Loan's experience in the Rural Physician Leadership Program allowed her to gain more hands-on experience with patients because of the hospital's smaller medical staff and fewer residents in the program, Adams reports. She has delivered more than 10 babies, assisted attending physicians with bowel surgery and helped stabilize a coding patient in the emergency department.

During her stint, Loan participated in a clerkship and lectures at St. Claire Regional Hospital in Morehead. Dr. Phillip Overall, the emergency clerkship director at the hospital, told Adams that Loan has already demonstrated the calm and decisive qualities needed in an emergency-room doctor.

"She is able to think very quickly on her feet and subsequently provide excellent patient care," Overall told Adams. "We take care of critical patients on a daily basis, and she is absolutely able to step back and assess the entire situation calmly and come up with a plan to take care of the patient."

The assistant dean who recruited Loan to the Rural Physician Leadership Program, Dr. Anthony Weaver, said that rural practices and hospitals need physicians who are committed to living and working in small towns. Loan's closeness to her family and ability to "have conversations with anyone about just about anything" made her an ideal candidate for the program, he told Adams.

"Ashley Loan has the intelligence and drive to succeed as a physician, but more importantly, she cares about her family and her neighbors," Weaver said. "Improvements in the health of rural Kentucky will come from people like Ashley."

Loan also received a certificate in health systems leadership upon graduation from medical school and will work toward a master's in business administration during her medical residency, which she is also completing at UK. Loan aspires to serve as the director of a rural emergency department.

Loan was once a high-school girl who wanted to escape rural Kentucky. Now, she not only has committed to practicing medicine in rural Kentucky, but she and her fiancé Ryan Brown have bought an 87-acre farm in Greenup County and built a house there. She plans to raise beef cattle when not practicing emergency medicine in a nearby hospital or responding to emergencies, Adams writes.

"I'm definitely a small-town person," Loan told Adams. "I feel an obligation to come back and serve the people who have really believed in me for so long. It makes my day when someone says, 'You are coming back here?' I'm Ashley—I'm the girl who sold corn with her dad on the side of the road—they trust me, and I like that." (Read more)

Wednesday, May 21, 2014

Sunscreen, sunglasses. This should be your mantra as you step into the great outdoors this summer.

Your skin needs protection from the damaging rays of the sun but so do your eyes, says the Kentucky Optometric Association.

“People spend a lot of time outdoors in the summer, so too much exposure to the sun is common,” Dr. Lynn Shewmaker, an optometrist with offices in Fort Mitchell and Dry Ridge says in a news release. “Sunglasses are more than just a fashion accessory because overexposure to ultraviolet rays fast forwards aging of the eyes and increases the risk for serious diseases.”

The Optometric Association reports that the sun’s UV radiation can cause cataracts; cancer of the eyelids and skin around the eyes; benign growths on the eye’s surface; and what is commonly known as snow blindness, which is a temporary but painful sunburn of the eye’s surface. Long-term exposure can cause damage to the retina, a lining of the eye that is used for seeing.

Extended sun exposure can also create visibility problems for drivers. “Spending just two or three hours in bright sunlight can hamper the eyes’ ability to adapt quickly to nighttime or indoor light levels,” Shewmaker said in the release. “This can make driving at night after spending a day in the sun more hazardous.”

Long-term sun exposure is also a risk factor for macular degeneration, a disease that destroys the part of your vision that allows you to see objects clearly, says the release.

Wearing a wide-brimmed hat or cap can block about 50 percent UV radiation from the eyes, which is not enough protection, according to the release. You must also wear sunglasses.

The Kentucky Optometric Association recommends choosing lenses that:
· Block 99 to 100 percent of both UV-A and UV-B radiation
· Screen out 75 to 90 percent of visible light
· Are perfectly matched in color and absorption and are free of distortion and imperfection
· Are gray for proper color recognition.
In addition, Shewmaker said some contact lenses also can block out both UV-A and UV-B radiation.

Infants’ and children’s eyes also need to be protected from the sun at all times especially because they tend to spend more time in the sun than adults.

Monday, May 19, 2014

With two lawsuit settlements from drug makers, Attorney General Jack Conway is giving the University of Kentucky $1.5 million over two years to develop a comprehensive plan for the prevention and treatment of substance abuse by adolescents.

“Adolescent substance use is at epidemic proportions,” Conway said in a press release. “A 2011 study from the Centers for Disease Control documented that 66 percent of Kentucky kids have used alcohol, 37 percent have used marijuana, and 19 percent have abused prescription drugs. This grant will allow us to explore all of the resources available to Kentuckians to fight this growing problem.”

The grant is intended to address all aspects of adolescent substance abuse, including community and physician outreach and education, treatment plans, and outcomes measurement. Funding of $19 million from the $32 million in settlements is already being used to create a program that addresses every stage of adolescent substance abuse, KY Kids Recovery.

"Our goal is to develop a start-to-finish plan with elements that offer evidence-based treatment, reach out to teachers, families, primary care providers and pharmacists, and target resources to communities with the highest need," said Dr. Catherine Martin, director of the new program and UK's Division for Child and Adolescent Psychiatry. “The program will utilize only treatments with a proven track record of success.”

The settlement is also providing $500,000 to complete construction of a Recovery Kentucky center in Ashland, $2.5 million for almost 900 scholarships over two years to Recovery Kentucky centers, and $560,000 to create 14 drug-free homes for people completing and transitioning out of residential substance abuse treatment programs.

In addition, the following entities will receive funds over the next two years from the settlement:
· $6 million to administer and upgrade KASPER, Kentucky’s electronic prescription drug monitoring program.
· $600,000 over two years to support substance abuse treatment for pregnant women by Chrysalis House in Lexington.
· $400,000 over two years to support substance abuse treatment for pregnant women by Independence House in Corbin.
· $1 million to develop a school-based substance abuse screening tool with the Kentucky Department of Education to intervene with at-risk children before they enter judicial or social services systems.
· $250,000 to create a database to evaluate outcomes of juvenile treatment.

Jails, treatment facilities, drug courts and hospitals are struggling to provide the necessary help as more Kentuckians become addicted to heroin, Chris Kenning writes for The Courier-Journal: "In a state that already had a shortage of drug-treatment options, the heroin problem is badly outstripping Kentucky's ability treat it."A Kentucky Health Issues Poll found that 9 percent of Kentuckians and 15 percent aged 18 to 29 reported awareness of a family member of friend struggling with heroin.
"We're just bursting at the seams," said Karyn Hascal, who is head of The Healing Place, a Louisville drug-treatment center. "I've been around 35 years, and I've never seen anything hit this fast and this hard." Though heroin users were few and far between several years ago, now they take up 90 percent of The Healing Place's detox beds.

The Louisville jail deals with 30 to 90 inmates every day. It has hired four around-the-clock detox nurses, started new detox dorm programs and added training officers since 2012, and "increased our inmate health-care budget by hundreds of thousands of dollars," said Metro Corrections director Mark Bolton.

Heroin may be "the most addicting drug there is," said Dr. Christopher Stewart, an addiction psychiatrist and medical director at the Jefferson Alcohol and Drug Abuse Center. Heroin crosses the blood-brain barrier and becomes morphine, "binding to opioid receptors in the brain and sparking an intense rush of pleasure and euphoria—one that's far more sharp and immediate than opiate pills," Kenning writes. People become immune to its effects and need to take more of it, and withdrawal symptoms include pain, vomiting, insomnia, spasms and cravings.

While longer-term treatment for severe addictions often includes patient resident programs including counseling, Kentucky lacks this kind of care. "There are not enough open-entry detox and treatment beds in this community—I'm talking non-insurance beds," Bolton said. Dr. Eric Fulcher, an emergency room doctor said that providing emergency treatment for heroin addicts has become "the new normal" at Sts. Mary and Elizabeth in the South End. "We're so used to it, we're almost numb to it."

Although the former director of the Office of National Drug Control Policy, Gil Kerlikowske, recommended the increased availability of naloxone, used to counteract heroin overdoses, the General Assembly didn't pass a bill "that in part would have made naloxone more widely available, along with other heroin-related measures," Kenning writes.

Jefferson District Judge Stephanie Pearce Burke said that "heroin use is present in more than three-quarters of her cases." Something has to be done. "People still have the idea that it's a drug from the '60s and homeless people in the park," she said. "But the face of heroin has changed. It's suburban teens and middle-class housewives, too." (Read more)

People gathered at the Lexington Senior Citizens Center May 16 to discuss problems with long-term care and potential ways to improve it, at an event organized by the Nursing Home Ombudsman Agency of the Bluegrass. Gov. Steve Beshear requested that such forums occur across Kentucky.

Attendees split into groups to discuss various topics regarding care of the aging in Kentucky. DG Gridley, founder of Grace Place, said that when she gets older, she would like to continue living in her own house but go to a facility during the day. Grace Place, staffed by medical professionals, is a health club for seniors. Several attendees said care in a nursing home should be based the preferences of each resident. For example, if the requirements were that each resident get a bath twice per week, and one resident wants a bath every day, he or she should be able to do that.

Some attendees encouraged others to speak up when they think elders are not being properly cared for. If something seems out of line, investigate, but people should also share positive stories, they said. Discussing such topics will help get people involved in such issues, some said.

Do you have complaints or comments about long-term care in Kentucky? Do you have suggestions to improve care for the aging population? Send your comments to nhoa@ombuddy.org. Comments will be sent to Beshear. All submissions must be sent by Aug. 31.

Forum attendees addressed these questions:

1. What does quality care mean to you? What does quality care look like, feel like? What are the key components to quality care? Who is responsible for good quality care in each of the settings?

2. If you have used a facility (assisted living, personal care, adult day and nursing homes) what did you like the most? The least? If you could make one improvement in a facility placement, what would it be?

3. What are the qualifications of a good caregiver regardless of the setting? How does staff impact care? Is staff education and training important? What topics/techniques should staff learn to address or demonstrate proficiently?

4. In a facility, is the number of staff persons on duty important, or is the quality of the staff more important? Why do you feel that way?

5. Where do you believe abuse and neglect are most prevalent? Knowing the definitions of abuse, neglect and exploitation which do you think is the biggest threat to the elderly and why? What might reduce these threats and help the elderly live safer higher quality lives?

6. Community involvement aids facilities, caregivers and providers in ensuring quality care and quality living for Kentucky's vulnerable citizens. How can members of our community be more involved in ensuring quality living and quality care for the elderly and individuals with disabilities?

Friday, May 16, 2014

Approximately 24 states still have not participated in health reform's Medicaid expansion, which provides coverage for adults who earn up to 138 percent of the federal poverty level. Some Republican-controlled states are "still looking for alternative ways to accept hundreds of millions, and even billions, federal dollars to expand coverage—all the while trying to maintain some rhetorical policy distance" from the controversial law, Jason Millman writes for The Washington Post.

Republican Gov. Mike Pence of Indiana is discussing a new plan to provide coverage for low-income people through an existing state insurance program. remains to be seen whether the federal government will approve Pence's plan or ask him to make changes. It also remains unclear whether the program will be better than traditional Medicaid.

When Pence said last year he would only consider expanding coverage if it was through the Healthy Indiana Plan, the Obama administration said the state couldn't do that because the program had an enrollment cap and potential cost-sharing issues. Now, Pence plans to get rid of the enrollment caps and make the program available to all adults who earn less than 138 percent of the poverty line. "Between 334,000 and 598,000 people will be covered under the plan, according to Pence's office," Millman writes. "Enrollment will open in 2015, with federal approval."

The current program only provided coverage for those under the poverty line and required them to pay for the first $1,100 of their care, the new program will provide two levels of coverage. Participants will be allowed to make monthly payments, but if they do not, they'll be given simpler coverage that doesn't include vision and dental benefits. The lesser coverage calls for co-payments for services but not for preventive care and family planning services. Participants living above the poverty line who do not give a monthly payment within 60 days will be "locked out of the program for six months. They can't opt into the basic coverage level," Millman writes.

"Exposure to and awareness of the cost of care are key components of the consumer-directed model that encourages price and quality transparency from providers," according to a document from Pence's office. "The increased deductible aligns with private market high deductible health plans paired with a health savings account, providing members valuable experience with a private market plan design." (Read more)

Though Pence does not support President Obama's health-care overhaul, the governor said that states "have an obligation to lead the way on health care reform," Maureen Groppe and Barb Berggoetz write for The Indianapolis Star. Pence said, "Reforming traditional Medicaid through this kind of market-based, consumer-driven approach is essential to creating better health outcomes and curbing the dramatic growth in Medicaid spending." (Read more)

Louisville-based "Humana Inc. faces multiple federal investigations
into allegations that it overbilled the government for treating elderly
patients enrolled in its Medicare Advantage plans, court records reveal." So reports Fred Schulte of the Washington-based Center for Public Integrity, a non-profit, inevstigative news agency.

"The status of the investigations is not clear, but they apparently
involve several branches of the Justice Department," Schulte reports, adding that federal prosecutors said in a document filed in March that they expect at least one of the investigations will be completed “in the next few months.”

Federal prosecutors in West Palm Beach have "opened a criminal case involving overbilling allegations that the
government says is similar to the Miami investigation," Schulte writes. "Meanwhile, the
criminal division of the Justice Department in Washington has reviewed
fraud allegations against the company, according to court records. Humana, which insures more than 2 million people through the Medicare
Advantage plans, is also the target of two Florida whistleblower civil
lawsuits that allege similar overcharges."

Humana spokesman Tom Noland told Schulte that the
company has made “several public disclosures about these matters over a
long period of time” and “self-reported” them several years ago,
but “Humana to our knowledge is not the subject of any criminal
investigation.” (Read more)

Thursday, May 15, 2014

A antidepressant that is often prescribed might slow production of amyloid beta, which is part of what causes Alzheimer's disease, according to new research from Washington University School of Medicine in St. Louis and the University of Pennsylvania. Science Translational Medicine published the research, which described mouse studies examining a variety of antidepressants.Brain plaques are related to memory issues involved with Alzheimer's, and scientists showed that the antidepressant citalopram halted plaque growth in a mouse model of the disease. Also, one dose of the antidepressant reduced the production of amyloid beta by 37 percent in health young adults.
The research is promising, but researches warned people should not take antidepressants just to help reduce the risk of Alzheimer's disease. ". . . While antidepressants generally are well tolerated, they have risks and side effects," said senior author John Cirrito, PhD, assistant professor of neurology at Washington University. "Until we can more definitively prove that these drugs help slow or stop Alzheimer's in humans, the risks aren't worth it. There is still much more work to do."

Normal brain activity produces amyloid beta, but when too much is present, it can clump into plaques. Some of Cirrito's previous research revealed that serotonin, one of the brain's chemical messengers, decreases amyloid beta production. Because many antidepressants help serotonin circulate in the brain, Cirroto and first author Yvetter Sheline, MD, speculated about whether antidepressants might help slow the development of Alzheimer's.

"We also plan to study older adults who will be treated for two weeks with antidepressants," said Sheline. "If we see a drop in levels of amyloid beta in their spinal fluid after two weeks, then we will know that this beneficial reduction in amyloid beta is sustainable." (Read more)

A public forum on nursing-home care will be held Friday at 2 p.m. at the Lexington Senior Citizens Center on Nicholasville Road next to the University of Kentucky campus.

The forum "may reveal what, if anything, is being done in Kentucky to improve care in nursing homes," Kentuckians for Nursing Home Reform says in a news release. It says the event "is a result of direction from Gov. Steve Beshear that public forums be held across the state to give citizens a chance to present not only their complaints about long-term care, but suggest possible improvements.
Tomorrow’s forum is the only reaction so far to the governor’s request."

The forum is organized by the Nursing Home Ombudsman Agency of the Bluegrass.

Wednesday, May 14, 2014

A morbidly obese employee costs his or her employer approximately $4,000 more in health care and related costs every year than an employee of normal weight, according to a study in the American Journal of Health Promotion. Kentucky ranks ninth in obesity among the states.

As might be expected, the study also found that obese workers with high blood pressure, diabetes and high cholesterol brought more costs than obese workers without those conditions. "Someone who is overweight or obese and also has diabetes is more likely to file a short-term disability claim compared to someone who doesn't have diabetes but is overweight or obese," said Karen Van Nuys, Ph.D., lead co-author of the study and economist at Precision Health Economics in Los Angeles.

The study showed that an employee with a body mass index of 35 has almost twice the risk of filing a short-term disability claim or workers' compensation claim than an employee with a BMI of 25. A BMI of 30 or more indicates obesity. While employees who are of average weight incur approximately $3,830 each year in medical claims, sick days, short-term disability and workers compensation, and morbidly obese employees incur about $8,067 every year.

The researchers analyzed three years of data from almost 30,000 workers, including "self-reported employee health information, medical visits and prescription claim and employer-reported data on absenteeism, short term disability and workers compensation claims."

"Overweight/obesity are just one of several modifiable risk factors in the workplace—but ones that are most problematic right now because they're getting worse by the minute," said Ron Goetzel, Ph.D., of the Johns Hopkins Bloomberg School of Public Health and Truven Health Analytics. Van Nuys and Goetzel said their report is not meant to encourage employers to discriminate against overweight people, but Goetzel said employers should "invest in robust, comprehensive health promotion programs for their employees that include physical activity, healthy eating, stress and depression management and control of blood pressure and diabetes." He added, "If you do those in combination and you do them right, not only is [this type of intervention] cost-effective, in some cases it is cost-beneficial, so that there is potentially even a return on investment here for employers." (Read more)

Addiction to prescription painkillers, and increased addiction to heroin by people originally hooked on prescription medicine, is "a public health disaster of catastrophic proportions" that "was caused by the medical community," the chief medical officer of a New York drug-treatment program said at a U.S. Senate hearing Wednesday.

"The medical community, including dentists, must prescribe more cautiously," Dr. Andrew Kolodny of Phoenix House told the U.S. Senate Caucus on International Narcotics Control. In areas where abuse is rampant, "Treatment capacity does not come close to meeting demand," he said. "If we don't rapidly expand access to treatment, the outlook is grim." He also called for better education of physicians about the risks of prescribing painkillers.

Senate Republican Leader Mitch McConnell of Kentucky attended the first several minutes of the hearing and read a statement calling for the problem to be attacked by a combination of treatment and incarceration, with the use of multi-agency partnerships. He also said, "It's clear that the increase in heroin addiction is tied to our fight against prescription drug abuse."

Part of that fight included requiring Kentucky doctors to participate in the state's prescription-drug monitoring program, which Kolodny said made the state one of only three with such a requirement. The others are New York and Tennessee.

Officials have said that when Kentucky cracked down on disreputable "pill mill" pain clinics, making prescriptions harder to get, addicts turned to heroin. "Heroin is just a symbol for the prescription-drug problem," Joseph Rannazzisi, deputy assistant administrator of the Drug Enforcement Administration, told the senators.

Rannazzisi said the largely successful effort against pill mills in Florida has driven them to Georgia and Tennessee. He said Tennessee has 300 pain clinics. "They're moving north and west," he said. "Regulatory boards in the states need to take control."

Sen. Dianne Feinstein of California, the Democratic co-chair of the caucus, said the testimony made prescription-painkiller and heroin abuse seem worse than the drug problems she dealt with as mayor of San Francisco in the 1980s. "Nothing like today," she said. "I am really struck."

The Kentucky Hospital Association gave some awards during its annual convention in Lexington on May 9, according to a KHA press release. Stephen A. Williams, chief executive officer of Norton Healthcare in Louisville, received KHA's highest honor, the Distinguished Service Award. Recipients of this award must have not only provided extraordinary service to the association but also shown exceptional leadership in the health-care field.

Hardin County Judge-Executive Harry Berry, board chair of Hardin Memorial Health in Elizabethtown, and Bill Demrow, Stanford funeral director and former Lincoln County coroner who is vice board chair of Ephraim McDowell Health in Danville, received the Health Care Governance Leadership Award. It is bestowed upon people "who have had a positive and sustainable impact on the quality of care in their community," according to the release.

Tuesday, May 13, 2014

Fully one-third of Kentucky's counties will not have a hospital, following the closure of Nicholas County Hospital in Carlisle. That will make Nicholas the 40th county without a hospital, according to the Kentucky Hospital Association.

The hospital board said it searched "every possible option to keep the hospital open," but it has filed for bankruptcy and will close later this week, reports WLEX-TV. Officials reported that the 14-bed hospital was losing more than $100,000 per month, which they say resulted from a decrease in the number of patients and slow state and federal reimbursements, Sam Smith reports for WKYT-TV.

"It's a trickle-down effect that's going to impact the entire community and then there's the more critical life-saving aspect. There's a number of people within the community who are alive today because they were able to receive treatment at the hospital," hospital spokesman Stephen Scalf told WKYT.

Scalf said the hospital's clinics will close by Friday except for one rural health clinic that will likely remain open. Johnson Mathers Nursing Home,which operates on the same campus as the hospital, will not close."Nicholas County Hospital is operated by a private nonprofit organization, JMHC Inc., and has 44 full-time and 40 part-time employees who are being laid off," Karla Ward reports for the Lexington Herald-Leader.
The hospital's board said in a news release that it has been negatively affected by a national transition to "larger, urban-centered hospitals' that had forced many other rural health centers to close."

The fiscal court will be looking for options to create an "urgent treatment or ambulatory care facility that will provide for the community's medical needs in the future," WLEX reports. The county owns the hospital's property, and Judge-Executive Mike Pryor said other healthcare provers are considering taking over the space, Smith reports. "It's just another hit to us," said Pryor. "It's going to be something we are going to have to deal with, like we have in the past."

Monday, May 12, 2014

Most registered voters in Kentucky have an unfavorable view of the Patient Protection and Affordable Care Act when it is called Obamacare, but a plurality think favorably of Kynect, the brand name of the health-insurance marketplace that state government created under the law.

Those were among the findings of a poll taken April 30 through May 6 for NBC News by the Marist College Institute of Public Opinion in New York. It asked, "Overall, do you have a favorable or unfavorable impression of Obamacare?" The result was 33 percent favorable and 57 percent unfavorable, which was very close to voters' opinion of President Obama: 32 percent approval and 56 percent disapproval.

Last fall, the Kentucky Health Issues Poll found that people who weren't sure how Obamacare would affect them and their families had an unfavorable opinion of it, while those who said they did know how it would affect them had a favorable opinion.

In the recent poll, half the people were asked about Obamcare and the other half were asked, "Overall, do you have a favorable or unfavorable impression of Kynect?" The term was not defined. The poll found that 29 percent had a favorable opinion and 22 percent had an unfavorable opinion, while 29 percent said they had never heard of Kynect and 21 percent said they were unsure how to rate it.

Among people who identified themselves as Democrats, 39 percent were favorable and 15 percent were unfavorable; among Republicans, it was 16 percent favorable and 32 percent unfavorable. Among independents (who were 14 percent of the survey), opinion was 31 percent favorable and 22 percent unfavorable.

The only polling region where Kynect was not rated favorably was the Bluegrass and some surrounding counties, where opinion was 25 percent favorable and 28 percent unfavorable.

The poll asked all registered voters, "From what you have heard about the new health care law, do you think it is a good idea, a bad idea?" Then they were asked if they felt that strongly or not so strongly. The results showed polarization: 27 percent strongly felt it is a good idea, 43 percent said they felt strongly that it was a bad idea, and those who said their opinions weren't so strong were in the single digits. Eleven percent said they didn't have an opinion either way, and 4 percent said they weren't sure.

The poll, taken via landline and cell phones, has an error margin of plus or minus 1.9 percentage points. The Obamacare and Kynect questions have an error margin of plus or minus 2.9 percentage points. NBC News and Marist College took the survey mainly to gauge opinions in Kentucky's race for the U.S. Senate. For its release and the poll results, click here.

Paducah-area school districts "continue to adjust school meals to ensure students are fed complete, healthy meals every day," Kathleen Fox reports for The Paducah Sun.

The revised National School Lunch Program "places the emphasis on portion size and healthier food options such as fruits, vegetables and milk," Fox notes. "The requirements to make lunches and breakfasts healthier, which have been phased in over the last two school years, will continue to change for the 2014 school year.
All pastas and other grain products in schools will have to be whole-grain rich, defined as 51 percent or more of whole grain, and the first ingredient has to be whole wheat or grain."

Half the grain products in Paducah Public Schools are whole grain, and some are white to head off complaints, Nutrition Director Penny Holt told Fox. Holt "doesn't foresee major issues in switching the remain half to whole grain," Fox writes. "She said many of the whole grain products are popular with students including brown rolls, flatbreads, short slice Domino's pizza crust and honey wheat whole grain wraps."

"The healthier options are growing in popularity, especially with our younger kids who have become more familiar with them," Holt said. All children in the school system receive free breakfast and lunch as part of a special federal program for schools with a large percentage of children in poverty.

"Holt said the greater challenge will be adhering to the stricter sodium guidelines with meals and higher nutritional value for snacks or a-la-carte items," Fox reports. "Items that can be served other than those on the daily menu include baked chips and whole grain cookies, but nothing with minimal nutritional value such as soda or candy."

In the McCracken County Schools, Food Services Director Sara Jane Hedges "said the district already has success with many of its whole grain alternatives, including its pastas and pizza crusts," Fox writes. "She said the change toward healthier a-la-carte options, which now have to provide additional nutritional value, will not be a problem because the district has already worked toward offering foods that meet those guidelines." (Read more; subscription required)

Stimulant medications used to treat attention deficit hyperactivity disorder might also reduce smoking risk, particularly if the medication is taken regularly, according to an analysis performed by Duke University. The study, online in the journal Pediatrics, has special signifcance for Kentucky, which first among the states in smoking and percentage of young people diagnosed with ADHD.
"Given that individuals with ADHD are more likely to smoke, our study supports the use of stimulant treatment to reduce the likelihood of smoking in youth with ADHD," said senior author Scott Kollins, Ph.D., a professor of psychiatry and behavioral sciences at Duke.

ADHD, which causes hyperactivity, impulsivity and difficulty paying attention, is often treated with stimulant medication, behavior therapy or both. The smoking rates are much higher for people who have ADHD than for the rest of the population. "Studies have shown that youth with ADHD are two to three times mores likely to smoke cigarettes than their peers, and 40 percent of adults with ADHD smoke regularly, more than twice the rate" among adults without the disorder, a Duke release says.

Some studies regarding potential connections between the using stimulant medications and smoking showed that taking stimulant medications increases smoking, and others didn't reveal any effects. "It has been suggested that some people with ADHD 'self-medicate' their attention deficits using nicotine," said lead author Erin Schoenfelder, a Duke psychologist. "Our findings show that treating ADHD effectively with medication may prevent young people from picking up the habit."

So far, the Duke study is the largest meta-analysis about the effects of stimulant medications on smoking habits. It looked at 14 longitudinal studies about smoking and ADHD treatment. The study found a "significant association between stimulant treatment and lower smoking rates. The effect was larger in those with more severe ADHD and when participants took stimulant medications continuously," the release says. The researchers said more studies are required to figure out the nature of the stimulant treatment needed to assist in reducing smoking risk.

"This study may debunk the perception that stimulants will increase one's risk for smoking," Kollins said. Schoenfelder said, "My hope is that this research can help inform our efforts to prevent negative outcomes for kids with ADHD, including cigarette smoking. This population hasn't been targeted for smoking prevention efforts, despite the well-known connection between ADHD and smoking." (Read more)

Saturday, May 10, 2014

Kosair Charities, which gives more than $6 million a year to Kosair Children's Hospital in Louisville, has sued the hospital's parent, Norton Healthcare, accusing it of misusing some of the money "to enhance its bottom line and 'line the pockets' of its executives," and has "refused to provide an accounting of how Kosair's donations are spent," Andrew Wolfson reports for The Courier-Journal.

"Norton spokesman Thomas Johnson said the company 'categorically' denies that 'money designated for Kosair Children's Hospital was somehow spent for any other purpose or in any other Norton Healthcare facility'," Wolfson writes. "In a statement the company called the lawsuit 'baseless' and said, 'Over the last few years Kosair Charities has engaged in a systematic pattern of raising baseless allegations in an effort to avoid its contractual obligations to the children's hospital that carries its name.'" (Read more)

Thursday, May 8, 2014

In May the Kentucky Department for Public Health is observing Asthma Awareness Month by cultivating awareness about the disease's impact and working with the Kentucky Asthma Partnership to reach both health care providers and schools to assist people with asthma.

Asthma sometimes creates disability, reduces quality of life and diminishes work productivity. "While there is no cure for asthma, the burden of the disease can be lessened with proper management. With the right tools and resources, the numbers of missed schools days and work days, emergency room visits and hospitalizations can be greatly reduced," Public Health Commissioner Stephanie Mayfield, M.D., said in a news release from the Cabinet for Health and Family Services.

Kentucky has one of the nation's highest rates of asthma: one in 10 children and one in 11 adults. The disease costs Kentucky $399 million every year in direct medical costs, estimates the federal Centers for Disease Control and Prevention. Asthma also causes loss of money through work absenteeism and is one of the top reasons children miss school.

This month the state health department will collaborate with the Kentucky Asthma Partnership to encourage providers, schools and communities to both assist people with asthma and create an asthma action plan. "Educational tools will be made available, including Creating Asthma Friendly Schools, the EPR-3 Asthma guidelines and Asthma 1-2-3 Training. In addition, the American Lung Association of the Midland States will be sponsoring the Fight for Air Walk June 7 at Iroquois Park in Louisville," according to the press release.

According to health department staff, people need to know what to do in response to asthma attacks. "An asthma action plan helps patients identify when asthma is out of control and what steps need to be taken to respond to asthma attacks," said Pam Spradling, manager of the state asthma program. "Parents and caregivers can help schools identify children with asthma, make sure medications are available to the child and that an asthma action plan is on file," Spradling said. "Schools and workplaces can help reduce the risk of exposure to indoor asthma triggers year round by improving air quality and reducing exposure to second hand smoke."

To learn more, go to the Kentucky Asthma Program's website or the CDC's National Asthma Control Program website.

Tuesday, May 6, 2014

Dudley J. Conner of Frankfort, former executive director of the Kentucky Public Health Association and the Kentucky Health Department Association, died May 3 in Louisville at the age of 77. He was a tireless advocate for public health in Kentucky.

Conner was a 1954 graduate of Clinton County High School and Berea College. He received a master's degree in 1961 from the University of Minnesota School of Public Health and later a Master's in Public Administration from Eastern Kentucky University. He spent his career and much of his retirement working in public health, and was a past president of the Southern Public Health Association.

He is survived by his wife, Betty Williams Conner, formerly of Clarkson; a daughter, Tonya Rager of Lexington; a son, Timothy Conner of Jacksonville, Fla.; two granddaughters, three grandsons, and several cousins in Clinton and Russell counties.

Visitation will be Tuesday, May 6, from 5 to 8 p.m. at Harrod Brothers Funeral Home, 312 Washington St., Frankfort, and Wednesday, May 7, from 1 to 2 p.m. at First United Methodist Church, 211 Washington St., with services immediately following. Interment will be in the Frankfort Cemetery.

In lieu of flowers, expressions of sympathy may be made to the Kentucky Public Health Association Scholarship Fund, P.O. Box 4647, Frankfort KY 40604 or the First United Methodist Church Building Fund. Condolences may be shared via the online guest book at www.harrodbrothers.com.

Monday, May 5, 2014

The University of Kentucky Center for Trauma and Children sent out a report about the well-being of trauma-exposed families in which a grandparent is the primary caregiver and where no biological parent is present. The report calls these families "grandfamilies." In Kentucky, more than 67,000 children live with a grandparent, and biological parents are absent in more than half of those cases. "According to the study, substance abuse, child maltreatment and incarceration were the top three reasons these children lived with a grandparent," Elizabeth Adams writes for UK Public Relations.
The report also found that 73 percent of children in the sample of grandfamilies had suffered one or more traumatic experiences, and more than 16 percent had suffered four or more. Forty-three percent of the grandparents said their grandchild had a special mental-health need, and more than 17 percent said their grandchild had been diagnosed with a disorder related to trauma. Also, the grandparents participating in the study said they suffered from an average of at least two chronic illnesses.

Almost 300 grandparent caregivers participated in the study through the Caregiver Program for Grandparents Raising Grandchildren between March 2013 and December 2013. Both rural and urban families were interviewed. The study highlights a need for more specialized services for traumatic stress in children and "enhanced legal, financial and health care resources for their caregivers," Adams writes.

Dr. Ginny Sprang, director of the UK Center for Trauma and Children, served as the principal investigator for the study. To schedule an interview about the study, contact Elizabeth Adams at ElizabethAdams@uky.edu. Electronic copies of the report are also available.

By Al Cross
Kentucky Health NewsThe Paducah Sun relied on incomplete and inaccurate information for an editorial Thursday that criticized Gov. Steve Beshear's expansion of the Medicaid program under federal health-care reform, and the governor is complaining about it.

The newspaper said Beshear had created a "financial mess" because when he was running for governor, he "told our editorial board that he had 'no
idea where we would get the money' to pay the state's share of the cost of Medicaid expansion if the
Affordable Care Act was passed. He still doesn't."

Actually, when he announced the Medicaid expansion a year ago, Beshear cited a study by the international accounting firm PricewaterhouseCoopers which concluded that the expansion would pay for itself by adding patients to the health-care system and creating 17,000 jobs by the 2020-21 fiscal year.

The editorial made no mention of the study. Beshear's communications director, Kerri Richardson, told the paper Tuesday that the editorial was "grossly misleading, and we are disappointed that your editorial board has chosen not to seek information from anyone in our administration regarding actions on the Affordable Care Act."

In the formal response from Beshear, submitted for publication, the governor says the editorial "was so breathtakingly disingenuous that it demands a factual response. That a newspaper of this size would trot out such unsubstantiated tripe disguised as analysis is a disservice to its readers."

Sun Editor Steve Wilson said the editorial was written by Publisher Jim Paxton, who did not return a call seeking comment. The Sun's editorials generally support conservative causes and Republicans; Beshear is a Democrat and the only Southern governor to both expand Medicaid and create a health-insurance exchange under the reform law.

The editorial also misstated when Kentucky would have to start sharing in the cost of care for the newly eligible Medicaid recipients, those with household incomes between 69 percent and 138 percent of the federal poverty level. It cited a study by the conservative Heritage Foundation which "suggests that even when savings
from ACA managed-care features are added in, the expansion will cost
Kentucky an additional $846 million between 2014 and 2022."

Actually, the state will not have to pay anything for the newly eligibles until 2017 because the federal government will pick up the entire cost until then. In 2017, the state will have to pay 5 percent of their cost, rising to a cap of 10 percent in 2020. Republican critics of the law have said the cap will have to be raised, but have not found fault with the study.

Studies by the accounting firm and the University of Louisville's Urban Studies Center, drawing on Congressional Budget Office data, estimated the state would actually gain $802 million through the 2020-21 fiscal year from Medicaid expansion. "Without
expansion, our budget would see a negative impact of nearly $40 million,
because we would be forced to absorb costs such as increased payments to
hospitals for uncompensated care, " Beshear wrote. "In other words, the state would lose money if we didn’t expand."Click here for the rest of his reply.

Beshear said in his response that he sent the Sun an op-ed piece a year ago this week explaining the facts, but the paper apparently refused to publish it.

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!